Membership Consideration Application

To be considered for membership for DARN, you must first complete the below consideration application in its entirety.

Once your application is received and reviewed, a representative from our organization will contact you.

Thank you for your interest in our organization!

**If you were previously a member of DARN and your membership has lapsed, please contact us instead of filling out this form.

Name: *

(First, Middle, Last)

Call Sign: *

Licensed Since: *

(An approximation is OK)

License Class: *

Mobile Phone: *

Work Phone:

Home Phone:

Address: *

Address Line 1

Address Line 2

City

State

Zip Code

Email: *

Current or Past Occupation: *

Approximate Age: *

If you have any immediate family member(s) who are licensed operators and you would like them to be included with your application, please list their name(s) and call sign(s) here:

Please explain why you would like to become a member of the Disaster Amateur Radio Network and what areas you may be able to help within the organization: *

At which level membership do you wish to join? *

Please list two (preferrably current) amateur radio operator references:

Name: *

Call Sign:

(If applicable)

Phone: *

Current or Past DARN Member: *

Email Address: *

Name: *

Call Sign:

(If applicable)

Phone: *

Current or Past DARN Member: *

Email Address: *

Please list any current or past amateur radio clubs you have been associated with. If none, please write none in the space provided: *

Please write a summary of your amateur radio background, including the types of radios you own, as well as any other associating hobbies or avocations you believe have a nexus to joining our organization: *